Clinical Pathways

The U.S. healthcare landscape is an ever-changing environment.  There’s a constant evolution of healthcare policies, physician payment models, and approaches to care – all geared towards providing better care to Americans while managing costs. One such trend I have been hearing more and more about over the past year is the implementation of clinical pathways, also known as “care pathways” or “care maps.”

So, what is a clinical pathway?  The Children’s Hospital of Philadelphia explains “a clinical pathway is a task-oriented care plan that details essential steps in the care of patients with a specific clinical problem and describes the patient’s expected clinical course.”  Essentially, clinical pathways serve as a guideline for physicians to follow for a specific disease state.    A clinical pathway may outline a standard process for admitting or discharging a patient who presents with a specific disease state, and guides the physician in efficiently determining the right questions to ask about the patient to determine the best course of treatment or referral pattern.

Clinical pathways are meant to benefit patients, providers, and payers.  Clinical pathways are meant to ensure:

• Patients receive the most effective and tolerable treatment, while remaining cost-effective for them.
• Providers are consistent and have a guide to provide the best care when there are a variety of options to choose from.
• Payers’ interests are met in terms of cost effective treatments being utilized before extremely high cost products that may offer little benefit over the lower cost products.

Ultimately, the goal of clinical pathways is to standardize care, improve outcomes and reduce the cost of care.

Not all physicians and payers are in favor of clinical pathways.  Some physicians believe clinical pathways limit the physician from choosing the best care for their patient.  In addition, there can be concerns that the clinical pathways do not take into account the heterogeneity of their patient population or various comorbidities.  Some payers view the use of clinical pathways as a short term solution to address costs, but may not have an impact on cost in the long run.

Whether you believe clinical pathways are a positive or negative addition to the treatment paradigm, it is important to consider how they may impact utilization of a product. If you are conducting market research for a new pharmaceutical product, consider asking your respondents if there are any clinical pathways currently developed for the disease state of interest or if one is expected to be developed.  If there is, your research should explore how pathways could impact the extent to which a new product will be used.     As you explore or encounter clinical pathways in your research, keep in mind the following different ways a clinical pathway may need to be followed:

• The clinical pathway can be implemented by the hospital or by a health plan. Payers may require a provider to follow a specific pathway, and coverage and reimbursement may be dictated by use of the pathway.
• Depending on the organization, clinical pathways may be restrictive or flexible. If it is restrictive, physicians have to follow the clinical pathway and may face a penalty if the pathway is not followed, such as reduced reimbursement.
• Alternatively, some organizations implement flexible clinical pathways that serve more as a guideline for the physician, and they still have the freedom to choose whichever treatment they deem as most appropriate for their patients.

I hope this introduction to clinical pathways helps you uncover additional insights in your healthcare market research endeavors!

*Source: The Children’s Hospital of Philadelphia (CHOP) http://www.chop.edu/pathways#.VlXBL3arS00.